Against proportional shortfall as a priority-setting principle

Area of Science:

• Health Economics
• Bioethics
• Public Health Policy

Background:

• Rising healthcare demand necessitates robust priority-setting principles.
• Proportional shortfall is a prominent principle balancing prospective and lifetime health.
• The principle's justification hinges on accounting for lifetime health, deeming past health irrelevant.

Purpose of the Study:

• To argue against the adoption of the proportional shortfall principle.
• To critique proportional shortfall for its failure to adequately consider past health.
• To demonstrate the principle's inadequacy in incorporating the fair innings argument.

Main Methods:

• Philosophical argumentation and ethical analysis.
• Critique of the proportional shortfall principle's theoretical justification.
• Examination of scenarios where past health is relevant for priority setting.

Main Results:

• Proportional shortfall does not fully account for lifetime health as claimed, failing to incorporate the fair innings argument.
• The exclusion of past health is not always justifiable, especially when it impacts current/future health or when individuals have disparate healthy life years.
• Ignoring past health can result in double jeopardy, where individuals face compounded disadvantages.

Conclusions:

• The proportional shortfall principle should not be adopted due to its flawed consideration of past health.
• Past health is sometimes relevant and should be incorporated into healthcare priority-setting decisions.
• Rejection of proportional shortfall is warranted due to its potential for creating unfair outcomes like double jeopardy.